Rabasse, P 2010, To compare the efficacy of blood pressure reduction with or without the biochemical profile , PhD thesis, University of Salford.

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Abstract

Background - Resistant hypertension (RH) is common among adults with hypertension affecting up to 30% of patients on treatment for blood pressure (BP) control. It is predicted to increase, as old age and obesity are considered major risk factors for RH. Effective treatment of RH still remains an unmet goal of antihypertensive treatment. This thesis compared two methods of treating RH in two hospital settings, with or without the use of a biochemical blood test. Methods and Results - This was a prospective, quantitative cohort study conducted over 20 months. A total of 213 patients were recruited; 109 (100%) from site 1 (SI) and 111 (100%) from site 2 (S2). The mean age was 53.6 for S 1 and 55.1 for S 2 and there were 58 male patients from both sites (SI, 53% v S2, 52%). There were 12.9% v 18.21% smokers, 6.8 % v 15.3% diabetics, 54.1% v 79.3% hypercholesterolaemia and a family history of coronary heart disease 61.1% v 83.3% in SI and S2 respectively. The comparison of BP control between the two groups for the study period showed 30.5% from SI and 32.5% from S2 achieved BP control. A comparison at fixed time of three, six, and nine months SI v S2 (10.5% v 16.2%, 20.0% v 22.2%, 26.3% v 23.2%) showed no statistically significant difference in BP control. Among those aged <55yrs, 29.5% at SI v 36.4% at S2 achieved BP control. Among those aged >55yrs, 22.5% at SI v 34.5% at S2 achieved BP control, Conclusion - There was no statistically significant difference in BP control between those treated on the basis of a biochemical profile or on the nationally agreed algorithm. It can be proposed that health care professionals such as specialist nurses in cardiology could play a significant role in addressing this growing problem.

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